Surgical Sponge Research Articles

Thymine-modified chitosan with broad-spectrum antimicrobial activities for wound healing

Avoiding wound infections is a major challenge in wound care management, and new materials are urgently needed to address these problems. Herein, four water-soluble thymine-modified chitosan (TC) derivatives with the degree of substitution (DS) ranging from 0.23 to 0.62 were synthesized and freeze-dried to obtain porous sponge dressings. TC derivatives had broad-spectrum antibacterial activities against gram-negative bacteria, gram-positive bacteria, fungi, drug-resistance bacteria, Pseudomonas aeruginosa and Acinetobacter baumannii. Especially, the antioxidant and antibacterial properties of TC derivatives increased with increasing DS. Furthermore, TC derivatives showed excellent biocompatibility and blood compatibility. TC sponges could significantly accelerate the wound healing process than gauze and chitosan sponge. The histological analysis and immunohistochemical staining showed that the wounds treated with TC sponges displayed fewer inflammatory cells, and faster regeneration of epithelial tissue, collagen deposition and new blood vessel formation speed. Therefore, TC sponges can shed new light for wound dressing design.

Nasal Packing for Epistaxis with a Surgical Sponge by Non-otorhinolaryngologists

Nasal Packing for Epistaxis with a Surgical Sponge by Non-otorhinolaryngologists

Mediastinal Extraskeletal Osteosarcoma in a Canine with Pulmonary and Cerebral Metastasis

Background: Extraskeletal osteosarcoma (EOS), a rare variant of osteosarcoma (OS), is a malignant neoplasm that develops in soft tissues without primary bone involvement. This study aims to describe a case of EOS with a mediastinal location in a canine.Case: A 10-year-old male, Uruguayan, Cimarron dog was presented to the Laboratório Regional de Diagnóstico, Faculdade de Veterinária, Universidade Federal de Pelotas (LRD/FV/UFPel) for necropsy. The dog had a history of submandibular swelling, progressive hind limb paralysis, muscle atrophy, and breathing difficulties. During necropsy, in the thoracic cavity, approximately 900 mL of serosanguinous exudate and a reddish-brown, bossed mediastinal mass measuring 15.0 cm in the longest axis were also noted. The lung exhibited multifocal to coalescent, white, firm nodules extending from the pleura to the parenchyma and measuring up to 4.5 cm in diameter. In the parietal and occipital region of the brain, a matte wine mass measuring 2.3 cm in the longest axis was observed. Fragments of the neoplastic mass, organs of the abdominal and thoracic cavities, and the brain were harvested and fixed in 10% buffered formalin. After 48 h, the samples were routinely processed, incorporated in paraffin, cut into 3 µm-thick sections, and stained using Hematoxylin and Eosin (HE). Selected sections of the neoplasm, the lung, and the brain were subjected to Von Kossa staining and immunohistochemical (IHC) analysis. For IHC, primary anti-cytokeratin monoclonal antibodies (clone AE1 / AE3, BioCare Medical) at a 1:100 dilution, vimentin (clone V9, BioCare Medical) at a 1:100 dilution, S100 Protein (clone 15E2E2, BioCare Medical) at a 1:100 dilution, and Ki67 (SP6 clone, BioCare Medical) at a 1:50 dilution were used. Immunostaining was visualized using 3-3' diaminabenzidine (DAB). Histological evaluation of the mediastinal mass, the pulmonary nodules, and the central nervous system among polygonal mesenchymal cells was conducted. Marked pleomorphism with euchromatic, rounded to oval nuclei, evident nucleoli, and poorly delimited eosinophilic cytoplasm. Neoplastic cells were arranged in nests and bundles with an invasive growth pattern. Osteoid and bone matrix formation as well as multinucleated giant cells of the osteoclast type were observed. The bone matrix was better evidenced in Von Kossa staining. IHC in all analyzed sections of the neoplastic cells showed positive immunostaining for Vimentin and Ki67. In the sections incubated with anti-cytokeratin and S100 protein antibodies showed no presence of neoplastic cells.Discussion: The diagnosis of EOS was based on the absence of primary bone lesions during microscopic necroscopy and on the exclusion of other histogenetic origins using IHC. The absence of primary bone lesions was the main attribute that differentiates EOS from other variants osteosarcomas, such as central/medullary and surface OS (periosteal and paraosteal) most frequently in canine species. The origin of EOS is uncertain. However, its occurrence has been originated with in pluripotent cells or previous injuries, such as retention of surgical sponges and vaccination sites. In this case, since the animal had no clinical history of injuries or surgical procedures that could induce the formation of a mediastinal neoplasm, the probable origin of the neoplasm was pluripotent cells. In dogs, EOS occurs mainly in the mammary glands, digestive system, liver, spleen, and subcutaneous tissue. Furthermore, the mediastinal location observed in this study was described only in goats. The clinical signs are nonspecific and varies with the location of the tumor, as observed in the present report. EOS may also present mediastinal location in the canine species. Necropsy, histopathological examination, and IHC were essential to establish the diagnosis of this OS variant.

RETAINED SURGICAL SPONGE IN ABDOMEN – A CASE REPORT

Retained foreign body is a major complication that can occur in early or delayed postoperative period having both clinical as well as medicolegal implications. We hereby report a case of 47-year-old female with retained surgical sponge in abdominal cavity after hysterectomy. Thorough count of all sponges before and after any surgery can aid in avoiding such an undesirable event and preferable use of labelled sponges can help in early diagnosis in such cases.

Low-budget, single-session elimination of CIED pocket infection.

The dramatic increase in the use of cardiovascular implantable electronic devices (CIED) was associated with an increased rate of CIED infection, which has a high management cost. To test the safety and efficacy of a single-session protocol, aiming to reuse the infected pocket side and the same device and leads in patients with CIED pocket infection. We included patients with isolated pocket infection between January 2015 and November 2019. The Patient was prepared by taking a swab for culture and sensitivity before the procedure. The pocket was debrided and the capsule was removed, the pocket was rinsed with povidone-iodine and hydrogen peroxide mixture, then packed with gauze sponge soaked with povidone-iodine. The device was debrided using ultrasonic irrigation and sterilized using gas plasma. The device was reimplanted and the wound was closed in layers. During the period of the study, we had 12 patients with isolated pocket infection. Nine presented with erosion, two with impending erosion, and one with a chronic sinus. Patient's age was 61.5 ± 7.64 years. The infection was diagnosed 14.2 ± 8.22weeks post device implantation. They were admitted for 7.6 ± 1.54 days postprocedure. The follow-up duration was 26.5 ± 15 (1.7-52) months. Only one patient (8%) had a recurrence of the infection after 50 days of the procedure. Our protocol was successful in treating 92% of device-related pocket infection without the need to replace the device or the pocket side.

Creation of a novel inflatable vaginal stent for McIndoe vaginoplasty

To describe how to create an inflatable vaginal stent for use in McIndoe vaginoplasty that can be constructed using standard operating room supplies. Step-by-step video instructions that demonstrate how to construct and use an inflatable vaginal stent. (This video article was exempt from institutional review board approval.) SETTING: Academic hospital. A woman presenting with vaginal agenesis requiring a McIndoe vaginoplasty for the creation of a neovagina. A novel inflatable vaginal stent compliant with operating room procedures that is radio-opaque, functional, and can be used for patients with or without a functional uterus. The device is modeled after the effective inflatable vaginal stent that was previously commercially available but is no longer produced. Although a vaginal stent may be created in the operating room by placing surgical sponges inside a sterilized condom, many operating rooms have restrictions on equipment that can be brought into the operating room and special criteria for how to sterilize this equipment, and there are also restrictions against leaving non-radio-opaque objects "inside" the patient. The novel inflatable vaginal stent we have developed has multiple advantages compared with a rigid dilator: it is deflatable, so it does not cause trauma or interrupt the delicate tissue graft during insertion, removal, or repositioning; it is firm enough to conform and circumferentially press the tissue graft against the dissected vaginal space but is soft enough to decrease the risk of pressure necrosis or damage to the urethra; and it has a drainage port to prevent the buildup of a fluid pocket that could interfere with graft adherence. Our stent incorporates all these unique properties and can be easily constructed using sterile operating room supplies. The construction of this device requires a silicone Foley catheter, sterile foam sponges from a vaginal prep kit, a sterile radio-opaque sponge, a sterile vaginal ultrasound probe cover, a long Kelly, a 60-cc catheter tip syringe, a ruler, scissors, 0-vicryl suture, and sterile gloves. Effectiveness of a self-made inflatable vaginal stent using standard operating room supplies that meets operating room protocol standards. A standard dose of prophylactic antibiotics should be administered preoperatively to prevent surgical site infection. After placement of the tissue graft in the dissected neovagina cavity, the vaginal stent is placed and slowly inflated to circumferentially apply the tissue graft against the dissected vaginal space. The stent remains in place for 7 days and then should be removed in the operating room to allow for an examination under anesthesia, which provides the ideal setting to best evaluate the initial graft adherence. After careful inspection of the neovagina and tissue graft, a standard silicone vaginal mold is placed to maintain vaginal patency and prevent stricture of the tissue graft. The silicone mold should remain in place continuously until complete graft adherence occurs (approximately 4 to 6 weeks), and then it can be worn nightly until the patient is regularly sexually active. If at any point the patient discontinues nightly use of the silicone mold before regular sexual activity, vaginal stricture and a decrease in vaginal caliber will occur. Our novel inflatable vaginal stent is useful to surgeons performing a McIndoe vaginoplasty for vaginal agenesis with or without a uterus. It is compliant with operating room protocols and restrictions, as it is constructed from operating room supplies and is radio-opaque. Moreover, it is adjustable in size and effective in applying circumferential pressure for graft adherence. When used for segmental vaginal agenesis, the Foley catheter may be advanced through the cervix, then the balloon can be inflated, to stabilize the position of the stent during the first week postoperatively. The main limitation of this device is that it must be constructed by the surgeon, but the advantage of self-constructing the stent is that the size and shape can be tailored to conform to each individual patient. We prefer this inflatable vaginal stent to a rigid vaginal dilator in the first week of tissue healing to allow for easy insertion and removal of the stent without disrupting the tissue graft, to help prevent tissue necrosis, and to provide a fluid drainage port during graft adherence. We recommend this device as an ideal option for surgeons to consider when performing a McIndoe vaginoplasty.

Protective measures undertaken during chest tube thoracostomy in COVID-19 outbreak.

BackgroundCoronavirus disease 2019 (COVID-19) is a newly emerging infectious disease that was first reported in China and has become a worldwide pandemic. Many surgical procedures are continuing to be performed during this state of pandemic as is thoracic surgery. We present six cases of tube thoracostomy in COVID-19 patients and the modifications to the routine surgical technique.MethodsWe serially attached two closed underwater drainage systems (CUDS) together and added a high-efficiency particulate air (HEPA) filter to the port of the second CUDS, because the intrapleural air, which passes through the CUDS into the air in intensive care unit (ICU), may contain high concentrations of 2019 novel coronavirus (2019-nCoV). Second, we attached the chest drain to the first CUDS in order to prevent the spread of virus during the placement of drain into the pleural cavity. Third, just before opening the parietal pleura, ventilation was put on standby mode and the endotracheal tube was clamped to prevent viral dissemination to the environment. Fourth, we covered the incision with a gauze sponge soaked with sterile saline solution during pleural entry, to prevent viral dissemination into the environment.ResultsThere were a total of six patients enrolled in our study. All these patients were diagnosed with COVID-19. The surgical indication for the chest tube thoracostomy was tension pneumothorax in all six patents. All patients had lung expansion defects and subcutaneous emphysema after intervention. Unfortunately, all of them succumbed to COVID-19, despite best available treatment. There was no COVID-19 infection reported in the healthcare professionals during this study.ConclusionsThoracic surgical procedures may cause dissemination of high amounts of 2019-nCoV in the environment and thus are perhaps the most dangerous surgeries to perform. Variations in the thoracic surgical techniques are necessary in order to protect the healthcare providers from COVID-19.

Transmural colonic migration of a retained surgical sponge (Gossypiboma) which clinically mimicked a colonic tumor: A case report

Transmural colonic migration of a retained surgical sponge (Gossypiboma) which clinically mimicked a colonic tumor: A case report

Do we visually estimate intra-operative blood loss better with white or green sponges and is the deviation from the real blood loss clinically acceptable? Results from a simulated scenario study.

BackgroundThe intraoperative blood loss is estimated daily in the operating room and is mainly done by visual techniques. Due to local standards, the surgical sponge colours can vary (e.g. white in US, green in Germany). The influence of sponge colour on accuracy of estimation has not been in the focus of research yet.Material and methodsA blood loss simulation study containing four “bleeding” scenarios each per sponge colour were created by using expired whole blood donation samples. The blood donations were applied to white and green surgical sponges after dilution with full electrolyte solution. Study participants had to estimate the absorbed blood loss in sponges in all scenarios. The difference to the reference blood loss was analysed. Multivariate linear regression analysis was performed to investigate other influence factors such as staff experience and sponge colour.ResultsA total of 53 anaesthesists participated in the study. Visual estimation correlated moderately with reference blood loss in white (Spearman's rho: 0.521; p = 3.748*10−16) and green sponges (Spearman's rho: 0.452; p = 4.683*10−12). The median visually estimated blood loss was higher in white sponges (250ml IRQ 150–412.5ml) than in green sponges (150ml IQR 100-300ml), compared to reference blood loss (103ml IQR 86–162.8). For both colour types of sponges, major under- and overestimation was observed. The multivariate statistics demonstrates that fabric colours have a significant influence on estimation (p = 3.04*10−10), as well as clinician’s qualification level (p = 2.20*10−10, p = 1.54*10−08) and amount of RBL to be estimated (p < 2*10−16).ConclusionThe deviation of correct blood loss estimation was smaller with white surgical sponges compared to green sponges. In general, deviations were so severe for both types of sponges, that it appears to be advisable to refrain from visually estimating blood loss whenever possible and instead to use other techniques such as e.g. colorimetric estimation.

Gossypiboma with perforation of the umbilicus mimicking a complicated urachal cyst: a case report

BackgroundA retained surgical sponge, also known as a gossypiboma, is a rare cause of serious postoperative complications. Diverse retained surgical materials including instruments such as clamps and sutures have been reported, but surgical sponges are the most common material. We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus.Case presentationA 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Since the onset of symptoms, the patient had been treated conservatively in a peripheral hospital where she had been operated on. As no improvement was seen, an ultrasound scan was performed that suggested an intraperitoneal abscess adjacent to the umbilicus. Consequently, the patient was referred to our specialist outpatient department for surgical intervention. Suspecting a complicated urachal cyst, an exploratory laparotomy was performed but revealed a retained surgical sponge as the underlying cause. The gossypiboma was resected, and the postoperative period was unremarkable.ConclusionThis case demonstrates that gossypibomas, even though rare, continue to occur. They may clinically and radiologically mimic other pathologies, especially abscesses and tumors. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications.

A Curious Case of Gossypibioma

The term gossypibioma is used to describe a retained surgical sponge or gauze after operation. It is a rare but serious complication which is seldom reported because of the medicolegal implications. Gossypiboma usually has varied and vague presentation and is also difficult to detect on radiological investigations. It can even remain silent and present years after the operation. We report a case of a 74-year-old man who presented with chronic lump since 1 year in the right lumbar region. He had a history of spinal surgery 20 years ago.They had taken right iliac crest as a graft during that spinal surgery. Radiological investigations were inconclusive in detecting the retained gauze. A working diagnosis of soft tissue tumour-? Desmoid tumour was made on ultrasonography and an excision of lump was done where he was found to have a large gossypibioma densely adhered to the right iliac crest. Though rare, gossypibioma should be kept in mind as a differential diagnosis in postoperative cases presenting as vague pain or chronic lump even years after the operation.

Using Radiofrequency Technology to Prevent Retained Sponges and Improve Patient Outcomes.

Retained items (eg, sponges, sharps) after surgical procedures are reportable errors that can result in patient harm or death and increased patient and health care system costs. Perioperative use of radiofrequency (RF) technology may decrease the number of retained sponges and reduce hospital costs. We sought to determine whether the use of RF technology may be associated with fewer retained sponges, improved patient outcomes, and decreased hospital costs. We completed a retrospective evaluation of incident reports before and after implementing the use of an RF system for retained surgical sponges. We found that using RF technology was associated with fewer retained sponges and improved outcomes at our facility. We also determined that mortality rates before and after RF technology implementation were similar, and we estimated that our hospital's costs were reduced.

Transmurally migrated gossypiboma rarely posing as surgical site infection: a case report and review of literature

The term gossypiboma is used to describe a retained surgical sponge or gauge after surgery. The clinical features range from being asymptomatic to frank bowel obstruction, perforation and peritonitis. Radiological modalities also do not provide a definite diagnosis. We report a case of a 30-year-old lady who presented to the emergency room with recurrent surgical site infection. She had a history of caesarean section 5 months ago. Following the caesarean section, she developed superficial wound dehiscence which was re-sutured. At the present facility, the lady underwent Computed tomography (CT) scan and was suspected to have a foreign body around the gut. She was planned for an exploratory laparotomy. Upon laparotomy, a large thick-walled ileal loop with some unusual intra luminal mass was found. Dense adhesions were present between the ileal loop and sigmoid colon. Adhesiolysis led to an iatrogenic sigmoid colon perforation, around 2 cm length. On incision over the ileal loop, surgical sponge was retrieved. Ileal loop was resected along with perforated site with end-to-end ileo-ileal anastomosis was done. Primary repair of sigmoid colon perforation was done. Patient was stable in postoperative period. Although rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting with recurrent surgical site infection.

Choosing the Optimal Wound Dressing for Bathing After Total Knee Arthroplasty

BackgroundMany surgical dressings claim to be waterproof and safe for bathing postoperatively. The purpose of this study is to evaluate and compare the effectiveness of commonly used dressings' ability to prevent water penetration while bathing. Additionally, a survey was used to determine satisfaction and cost analysis performed. MethodsFour different dressings were applied to 17 subjects' knees: Aquacel, Opsite, Acticoat, and Tegaderm. A folded Medline Gauze Sponge was weighed and placed under each dressing before and after showering and bathing (submergence under water) in order to measure water penetration (change in weight of sponge in grams). A failure was defined as any dressing that allowed a sponge weight change greater than 1 standard deviation, or 3.9 g. All participants were additionally asked to complete a short survey after testing about the dressings. ResultsTegaderm was found to have significantly less water penetration than all other dressings except Aquacel and demonstrated no failures with showering, significantly less than all other dressings. Tegaderm was also found to have significantly less water penetration than all other dressings except Acticoat with bathing and had significantly less failures than all other dressings. Furthermore, Tegaderm was found to be the most comfortable and lowest cost per dressing. ConclusionTegaderm was overall the most effective at preventing water penetration, most comfortable, and most cost-effective. Aquacel was found to be equally as effective at preventing water penetration while showering but overall had more water penetration, had more failures, caused more discomfort, and was more expensive.

Morphology-controllable cellulose/chitosan sponge for deep wound hemostasis with surfactant and pore-foaming agent.

Developing a facile and scalable synthetic route is important to explore the potential application of functional cellulose sponges. Here, a simple and efficient strategy to produce porous and hydrophilic cellulose sponges using surfactant and pore-foaming agent is demonstrated. The obtained cellulose sponges exhibit high water absorption capacity and rapid shape recoverability. The introduction of chitosan endows the chitosan/cellulose composite sponge with good mechanical properties. Inhibitory effects on Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa are particularly proved. Besides, the result of the dynamic whole blood clotting time indicated that the chitosan/cellulose composite sponge has better coagulation ability than those of traditional gauze and gelatin sponge. Animal experiment further showed that rapid hemostasis within 105s could be reached with the composite sponge. Good biocompatibility of the composite sponge is proved by the results of hemocompatibility and cytotoxicity, indicating an excellent candidate as a rapid hemostatic material.

Rapid hemostatic chitosan/cellulose composite sponge by alkali/urea method for massive haemorrhage

Here, a simple and efficient strategy to produce porous and hydrophilic chitosan/cellulose sponge using surfactant and pore-forming agent is demonstrated. The preparation of composite sponge by LiOH/KOH/urea solvent system effectively solve the problems of uneven distribution of chitosan, poor softness and acid residue caused by soaking in chitosan acid solution. The obtained chitosan/cellulose sponges exhibit high water absorption capacity and rapid shape recoverability, as well as good mechanical properties. Effective inhibitory on Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa are particularly proved. Besides, the result of the dynamic whole blood clotting time indicated that the chitosan/cellulose composite sponge has better coagulation ability than those of traditional gauze and gelatin sponge. Animal experiment further showed that rapid hemostasis within 34 s can be reached with the composite sponge. Better biocompatibility of the composite sponge is proved by the results of hemocompatibility and cytotoxicity, indicating an excellent candidate for rapid hemostasis in massive haemorrhage.

Development of a Surgical Sponge Counting System Using Radiographic Images.

Background. Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using radiography in the operation room induces X-ray exposure for both patients and staff. To prevent such issues, a novel sponge counting system was developed. Each surgical sponge used in common hospitals is composed of single radiopaque fibers. Methods. The proposed system scans surgical sponges to estimate their fiber length (EFL) and returns the number of it. In this study, an optimal image acquisition protocol was determined that allows an accurate count of sponges. X-ray doses and multi-angle image procedures were tested. Results. Measurement trials were performed and compared for both dry and blood-soaked sponges. As a result, the X-ray dose of 50 kV and 600 μA and the acquisition of 180 images per sample yielded an accurate EFL. The 180-image protocol achieved good performance in this study and allowed counting of one package of 10 sponges in 226 seconds. For these settings, a significant correlation was found between the actual number of sponges and the estimated fiber lengths. Additionally, the performance of the system was similar for either dry or blood-soaked items. Conclusion. The proposed system could accurately count surgical sponges and is a promising option in preventing the accidental retention of surgical sponges.

Multifunctional Tissue-Adhesive Cryogel Wound Dressing for Rapid Nonpressing Surface Hemorrhage and Wound Repair.

Cryogels with tissue adhesion have great potential as wound dressings for rapid hemostasis for uncontrollable nonpressing surface hemorrhage and wound healing, but their use has not been reported previously. Herein, we designed a series of antibacterial and antioxidant tissue-adhesive cryogels based on quaternized chitosan (QCS) and polydopamine (PDA). These cryogels had good blood cell and platelet adhesion, enrichment, and activation properties for rapid nonpressing surface hemostasis and wound healing. The cryogels exhibited outstanding mechanical strength and easy removability, antioxidant activity, and NIR photothermal-enhanced antibacterial performance. The cryogels showed much better hemostasis than gauze and gelatin sponge in a standardized strip rat liver injury model, a standardized circular rabbit liver section model, and a pig skin laceration model. Furthermore, the excellent hemostatic performance of the QCS/PDA2.0 cryogel (containing 20 mg/mL QCS and 2.0 mg/mL PDA) for coagulopathic hemorrhages was confirmed in a standardized coagulation disorder rabbit circular liver section model. In addition, the QCS/PDA2.0 cryogel promoted rapid hemostasis in a deep noncompressible wound and a much better wound healing effect than a chitosan sponge and Tegaderm film in a full-thickness skin defect model. Overall, these multifunctional tissue-adhesive cryogels with excellent hemostatic performance and enhanced wound healing properties are suitable candidates for tissue-adhesive hemostat and wound healing dressings.

Novel technique using surgical scrub sponges to protect the nose and face during prone ventilation for coronavirus disease 2019.

Coronavirus disease 2019 is an international pandemic. One of the cardinal features is acute respiratory distress syndrome, and proning has been identified as beneficial for a subset of patients. However, proning is associated with pressure-related side effects, including injury to the nose and face. This paper describes a pressure-relieving technique using surgical scrub sponges. This technique was derived based on previous methods used in patients following rhinectomy. The increased use of prone ventilation has resulted in a number of referrals to the ENT team with concerns regarding nasal pressure damage. The described technique, which is straightforward and uses readily available materials, has proven effective in relieving pressure in a small number of patients.

Fact: Progressive Skin Prep Regimen Reduces Skin Contaminant Infections

Background The hospital was successful in reducing deep and organ space skin contaminant-related surgical site infections (SSI) by using a progressive skin cleansing regimen to reduce the concentration of transient and resident bacteria on the patient's skin. The adjunct procedure limits the risk of surgical site contamination of endogenous skin microbial pathogens. Methods An extensive review determined that the majority of primary organisms cultured from the Hospital Acquired Infections (HAI) were skin contaminate-related. Based on the review and surgeon recommendations, a task force implemented an adjunct cleansing regimen of 4% CHG surgical scrub sponge used PRIOR to 2% CHG “paint”. The combined cleansing regimen is used in addition to the traditional pre-surgical skin prep. The adjunct process reduces the concentration of transient and resident bacteria on the patient's skin, thereby limiting the risk of wound contamination. Further, the O.R. staff's skin preparation competencies were validated through return-demonstration. Just-in-Time education occurred if deviation from evidence-based practice occurred. Results The hospital saw a 68% decrease in the number of skin contaminant-related deep and organ space surgical site infections during the first six months following the initiation of the progressive skin cleansing regimen. Additionally, it was observed that the occurrence of HAIs deviated from the suggested 4% CHG soap and 2% CHG paint skin prep regimen, resulting in skin contaminant-related SSIs. Conclusions Implementing a comprehensive skin prep regimen eliminates the exposures that place patients at higher SSI risk. The goal to reduce/eliminate preventable skin contaminate-related infections and decrease the likelihood of hospital re-admissions following surgery was achieved. The hospital was successful in reducing deep and organ space skin contaminant-related surgical site infections (SSI) by using a progressive skin cleansing regimen to reduce the concentration of transient and resident bacteria on the patient's skin. The adjunct procedure limits the risk of surgical site contamination of endogenous skin microbial pathogens. An extensive review determined that the majority of primary organisms cultured from the Hospital Acquired Infections (HAI) were skin contaminate-related. Based on the review and surgeon recommendations, a task force implemented an adjunct cleansing regimen of 4% CHG surgical scrub sponge used PRIOR to 2% CHG “paint”. The combined cleansing regimen is used in addition to the traditional pre-surgical skin prep. The adjunct process reduces the concentration of transient and resident bacteria on the patient's skin, thereby limiting the risk of wound contamination. Further, the O.R. staff's skin preparation competencies were validated through return-demonstration. Just-in-Time education occurred if deviation from evidence-based practice occurred. The hospital saw a 68% decrease in the number of skin contaminant-related deep and organ space surgical site infections during the first six months following the initiation of the progressive skin cleansing regimen. Additionally, it was observed that the occurrence of HAIs deviated from the suggested 4% CHG soap and 2% CHG paint skin prep regimen, resulting in skin contaminant-related SSIs. Implementing a comprehensive skin prep regimen eliminates the exposures that place patients at higher SSI risk. The goal to reduce/eliminate preventable skin contaminate-related infections and decrease the likelihood of hospital re-admissions following surgery was achieved.